Provider Demographics
NPI:1447844824
Name:WOLF, WILLIAM AUGUST (MA, NCC, LAC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:AUGUST
Last Name:WOLF
Suffix:
Gender:M
Credentials:MA, NCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1511
Mailing Address - Country:US
Mailing Address - Phone:201-207-0325
Mailing Address - Fax:
Practice Address - Street 1:350 SPARTA AVE STE C2A
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1123
Practice Address - Country:US
Practice Address - Phone:973-726-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00546900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty